Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with the onset or first recognition during pregnancy,excluding diagnosed diabetes or prediabetes before pregnancy.It is one of the most common medical complications of pregnancy.There is almost no agreed diagnostic criteria for GDM until the hyperglycemia and adverse pregnancy outcome (HAPO) published in 2008.IADPSG published new diagnostic criteria for GDM,which is gradually acknowledged by the whole world.IADPSG diagnostic criteria has been adopted in China since 2011.Human insulin is the first-line therapy for GDM.Recently,insulin analogues such as insulin aspart and determir have been approved,and the safety and efficacy of oral antidiabetic drug-metformin are getting more and more attention and certification.Here,we reviewed the research progress of the diagnosis and treatment of GDM.

Objective To analyze the neurological manifestations and the imaging examimations the patients with fat embolism syndrome (FES) so as improve the early diagnosis and decrease mortality. Method The clinical manifestations and the related imaging examinations of 23 patients with FES were analyzed. Result 22 cases got complete recovery without any neuro-system sequla. One case died of respiratory failure. Conclusions Once nervous system symptom is observed in the patient with fracture,FES should be considered,and further examinations, such as MRI, should be performed.The patient who was suspected to be suffered from CEF has to take the skull MRI.

[Objective] In order to optimize the best condition for the water extraction process of Polysaccharides from Pleurotus ostreatus.[Methods]The single factor experiments were conducted,in which,the effects of radio of liquor to solid,irradiation time,temperature were studied separately.The orthogonal experiments were conducted to find out the appropriate operating conditions.[Results] The appropriate operating conditions are as follows:the radio of liquor to solid is 1:35.The irradiation time is 3h.and the temperature is 90oC.Under these conditions the average yield of Polysaccharides is 2.84%.[Conclusion]It is an ideal means for extracting Polysaccharides from Pleurotus ostreatus,with short time,less cost and sensitivity.

Objective To observe the changes in OLETF kideys at different stage and the beneficial influences by modulating serum lipids. Methods OLETF rats aged 8 wks were randomly divided into treated group and untreated group,and LETO rats served as normal control.Fenofibrate 20 mg/kg was given daily to the treated group.OGTT was performed at the age of 8,16 and 24 wks.Blood glucose,serum lipids and 24 h urine albumin excretion(UA) were investigated.The rats were killed at 16 and 24 wks of age,and the kidney sections were stained with PAS.Transforming growth factor-?_1(TGF?_1),vascular endothelial growth factor(VEGF) and fibronectin(FN) were investigated by immunohistochemistry assay.The electron microscope(EM) sections were made to measure GBM width and to observe the mesangial matrix.Results(1) Blood glucose had no significant difference between untreated and treated groups at 16 and 24 wks of age;(2) Fenofibrate decreased serum TG, increased HDL-C markedly but had no influence on LDL-C;(3) As aging,24hrs UA increased in untreated group,and reduced significantly in fenofibrate group at 24 wks of age;(4) TGF-?_1,VEGF and FN expressions were all higher in untreated group than in treated group at 24 wks of age.(5) EM revealed GBM obviously thickened and mesangial matrix widened in untreated group.Fenofibrate attenuated the kidney lesion greatly in EM picture.Conclusions (1) Dyslipidemia occurs prior to glucose metabolism abnormity in OLETF rats;(2) As aging,dyslipidemia progresses accompanying markedly the increased UA,enlarged glomeruli,thickened GBM and widened masangial matrix;(3) Modulating lipids early couldn′t improve glucose metabolism,but corrects dyslipidemia and reveals beneficial influence on kidneys;(4) The possible mechanism is that modulating lipids decreases TGF-?_1 and VEGF expressions.

SUMMARY Hyperparathyroidism is the clinical syndrome that results from elevated circulating parathyroid hormones,leading to multiple systems manifestations,and is divided into three kinds: primary, secondary and ternary.This patient’s main chief complaint was intermittent melena for 3 days,with the diagnosis of upper gastrointestinal hemorrhage according to endoscopy. Hypercalcemia, hypophosphatemia and high level of circulating parathyroid hormone and chronic renal failure were also found during hospitalization. Furthermore, MIBI showed a parathyroid adenoma located near the isthmus in the lower part of the left lobe. The patient had undergone nephrectomy because of kidney carcinoma 2 years ago. Primary hyperparathyroidism usually has the common gastrointestinal syndrome , but upper gastrointestinal hemorrhage reported as the chief complaint is rare and we had never seen similar reports before.

OBJECTIVE To investigate the risk factors,characteristics,measures of prevention and treatment of hospital fungal infection among maintenance hemodialysis patients.METHODS Clinical data of 128 maintenance hemodialysis patients between Jan 2002 and Dec 2006 were enrolled in this retrospective study of hospitalized infection cases.RESULTS During above period,36 infection episodes of 27 cases were occurred.The major infection site was lungs(69.4%).the Candida albicans was the main pathogen species(61.1%).The underlying and complicating diseases such as diabetes,chronic obstructive pulmonary disease and tumor,long antibiotics using,long hospitalization,poor nutrition status,inadequate hemodialysis,and venous indwelling catheter were the risk factors which led to fungal infection among maintenance hemodialysis patients.CONCLUSIONS The maintenance hemodialysis patients are easy to induce fungal infection.The C.albicans is the main pathogen species.The incidence of underlying diseases is rather high.Treatment of original diseases and complicating diseases,the standard using of antibiotics,adequate hemodialysis,the nutrition status and the reduction of the indwelling time of venous catheter are all the keys to decrease the fungal infection.

Objective To find out the clinical characteristics of the group of lymphoma patients with original appearance of abdominal mass through analysis of their clinical manifestation,pathology and treatment outcome.Methods Retrospective study of clinical data of 35 cases,who were admitted to PLA General Hospital from 1998 to 2003,was made as to their age,sex,pathological pattern,size of the mass at diagnosis,and accompanying symptoms,blood examination,therapy and effect with follow-up of 16~96 months.Results Seventy-four point 3 percent of the patients were male,and most of them(71.4%)with enlarged post peritoneal lymphatic nodes.Ninety-one point four percent of the patients were non-Hodgkin lymphoma and nearly half of them aged between 40 to 50.NHL patients(65.6%)of B-cell origin were more than those of T-cell origin(28.1%).One out of three HL patients died of disease relapse.Nine NHL patients died,including 6 who received conventional chemotherapy and 3 who underwent stem cell transplantation.Half of the patients(2/4)who had hepatic dysfunction and acites died.Conclusion Lymphoma patients with original appearance of abdominal mass are mostly seen in male,and most are of B cell origin.Huge mass,acites and hepatic dysfunction indicate unfavourable prognosis.LDH and ?_2-MG may be two of the prognostic factors.

Objective:To investigate the management of pelvic injury associated with complete anterior sacroiliac joint dislocation.Methods:In the study, 6 cases of pelvic injury associated with complete an-terior sacroiliac joint dislocation treated in Beijing Jishuitan Hospital from February 2008 to June 2014 were analyzed.We described the history and severity of injury, emergency treatment, and fracture radio-logy.In all the cases, the surgical treatment and postoperative functional exercise were performed.We followed up all the cases on an average of 1.6 years, assessed the postoperative recovery and summed up the treatment experience.Results:All the 6 patients with fractures recovered without infection and nerve symptoms after surgery.Their X-rays showed good reduction of sacroiliac joints.All the cases were followed up on an average of 1.6 years.Six months after surgery, the Majeed scores were perfect in 2 cases, good in 2, fair in 1, and poor in 1.The patients with poor scores suffered persistent pain, and decreased physical activity, and when walking long distances, they needed a walking stick.The 2 patients with low scores could not resume the original work.Conclusion:Pelvic injury associated with complete anterior sacroiliac joint dislocation is a special type of the pelvic injury since the managements during the emergency phase are difficult.The surgery should be done as early as possible, and the anterior approach is available for the reduction and fixation.

Objective To evaluate the results of operative treatment of comp ou nd acetabular fractures through single ilioinguinal approach. Methods 46 cases o f compound acetabular fractures were treated through single ilioinguinal approac h from June 1994 to October 2003 in our department. Their functional recovery an d complications were followed up. Results On the average, 40 cases were followed up for 40.4 months. All the fractures healed and no infection was found. Clinic al results were excellent and good in 33 patients, and only one patient showed s light ectopic ossification after the operation. Conclusions Acetabular fractures associated with anterior and posterior hemi-transverse fractures, most both co lumn fractures and some T shape fractures can be treated through the single ilio inguinal approach which can result in good reduction, satisfactory functional re covery, less invasive incision, and low rate of postoperative complications.

Objective Reninoma is a rare benign tumor of the renal juxtaglomerular cell apparatus that causes hypertension and hypokalemia via hypersecretion of renin,while it is extremely rare that reninoma induced hypertensive crisis with reversible posterior encephalopathy syndrome (RPES).To improve the clinical understanding for this disease,we conducted a case-analysis.Methods To analyze the clinical and pathological data of a case of reninoma-induced hypertensive crisis with reversible posterior encephalopathy syndrome,who was admitted to Peking University First Hospital in November,2007 and follow-up.Results This was a 16-year old female patient,onset with suddenly spasm with loss of consciousness,while blood pressure stepped up to 210/140 mm Hg( 1 mm Hg =0.133 kPa),and the head magnetic resonance imaging (MRI) revealed “multiple long-T2 signal”,and hypopotassaemia(2.8-3.2 mmol/L),urine protein positive,ultrasoundcardiogram revealed left ventricular hypertrophy,laboratory study revealed hyperreninism (38.23ng · ml-1 · h-1,normal range 0.07-1.15 ng· ml-1 · h-1 ) and hyperaldosteronism(660.9 ng/L,normal range 60-174 ng/L),abdominal CT-Scan revealed a mass at right kidney,blood pressure achieved safety range and the head MRI was rechecked and revealed “the abnormal long-T2 signal disappeared”.The clinical diagnosis was reninoma induced hypertensive crisis with RPES.The tumor was resected and the pathologic diagnosis was reninoma.The patient remained normotensive in the postoperative period without any medication.Conclusions Reninoma represents a rare but surgically curable cause of hypertension,thus the clinical suspicion of it is very important in young patients.If the diagnosis is confirmed,positive treatment must be done immediately to improve the prognosis.The most common cause of RPES is hypertension,and the diagnosis depends on the distinctive head MRI.There is always a good prognosis with the decline of blood pressure rapidly.